The final version of the draft protocol for the diagnosis and treatment of Crohn’s disease in children, developed by experts of the Russian Society of Pediatric Gastroenterology, Hepatology and Nutrition, is presented in the article. This project has been repeatedly discussed by pediatric gastroenterologists - specialists in the study of IBD in children during round tables at the XXV-th and XXVI-th Congres of Pediatric Gastroenterologists of Russia and, after final approval, will be presented in the form of clinical recommendations.

(IBD), who were for the first time treated with TNFα blocker (infliximab). Our aim was to determine prognostic informative value of the immunological parameters in order to assess the treatment efficiency. A comprehensive research included seventy children with IBD from 12 to 18 years old in the course of specific treatment (49 children with CD, 21 children with UC).The comparison group consisted of fifty healthy children of similar age who were subjected to a similar detailed examination. The patients were divided into two groups, depending on their therapeutic response following 1 year of biological therapy: the first group showed a persistent positive effect of the drug, and the second group exhibited only unstable effects of the treatment. We determined the contents of major and small subpopulations of peripheral blood lymphocytes before the first administration of infliximab. Immunophenotyping was performed by multicolor flow cytometry (FC 500), using the CD45, CD3, CD4, CD8, CD19, CD16, CD56, HLA-DR, CD5, CD161, CD127, CD25, and CD294 markers.We have revealed that the content of B lymphocytes was significantly reduced in children with unstable effects of therapy. By contrast, the B lymphocyte levels in children with persistent positive therapeutic effect did not differ from the comparison group. Analysis of the composition of the B lymphocyte profile showed an imbalance in the B1-to-B2 cell ratio, with decreased of B1 cell counts in IBD patients against the comparison group. In addition, the patients with unstable therapeutic effect showed a significant decrease in B2 cell numbers compared with a group with persistent effect and comparison group. The numbers of NK cells in IBD patients were found to be reduced against the comparison group. Assessment of T lymphocytes subsets revealed a number of features in the patients with minimal therapeutic effects, i.e., an increased level of activated T helper cells (CD4+CD25+CD127high) and Th17 lymphocytes (CD3+CD4+CD161+), as compared to children with stable effect of treatment and to the comparison group. Moreover, in children with minimal effects of therapy, the levels of Tregs within T-helper cell subsets were significantly higher than in the comparison group. By means of ROC analysis, we have identified most informative parameters for the groups with minimal versus persistent therapeutic effect, and showed a good quality for a discrimination model involving relative amount of Th17 cells, activated T helper cells and B lymphocytes. The number of Тh17 lymphocytes (% CD3+CD4+ lymphocytes) allowed to predict the effect of therapy with a TNFα blocker with high probability. The present study enables us to propose cellular immunity testing, as a promising tool for monitoring clinical state of IBD patients.

Anemia is one of the most frequent complications of inflammatory bowel diseases, which occur, according to various sources, in 6–74% of patients with these forms of pathology. The pathogenesis and treatment of anemia in inflammatory bowel diseases have a number of peculiarities. Thus, for example, not every anemia — iron deficiency and, accordingly, its correction is limited to only iron administration. The review analyzed the multifactorial nature of anemia in inflammatory bowel diseases, its influence on the course, and prognosis of the main disease; modern therapeutic agents are described.

Tricho-hepato-enteric syndrome (syndromic, phenotypic diarrhea, SD/THES) is a rare inborn disease, which affects bowels. It is caused by the mutation of genes SKIV2L or TTC37. Manifestations include intrauterine hypotrophy, severe chronic diarrhea, which starts in infancy, characteristic facial features and hair growth abnormalities, immune disorders. There are data on two patients dealing with tricho-hepato-enteric syndrome with underlying Crohn’s disease. This is the first description of cases of aggravated tricho-hepatoenteric syndrome ever found in Russian medical literature.

Ulcerative colitis is recurrent inflammatory disorder of the large intestine characterized by continuous expansion of bowel involvement, from the rectum to the proximal parts. Despite certain similar sign with adults, ulcerative colitis in children has a number of special features and distinctions to disease course and therapy response, therefore such peculiarities should be considered while choosing the management strategy. In 2012 European Crohn’s and Colitis Organisation and European Society for Pediatric Gastroenterology, Hepatology and Nutrition developed collaborated recommendations on diagnostics and treatment of ulcerative colitis in children based on the evidence-based medicine. On the base of European recommendations and with regard to Russian peculiarities and experience of management of children with ulcerative colitis the Russian Consensus on Ulcerative Colitis in children was developed by the group of the chief pediatric gastroenterologists specializing in inflammatory bowel diseases in children. This Consensus was approved on the 15th of February 2013 at the Expert Counsel on Development of the Russian Consensus, which took place during the XVII Summit of Pediatricians of Russia. These recommendations contain standardized protocols, which allow to provide timely and efficient diagnostics, treatment and follow-up of children with ulcerative colitis. It is necessary to mention, that this Consensus is not a doctrine and individual features of each patient and modern scientifically based data must be taken into account.

This paper shows the research results of the biological therapy with chimeric monoclonal antibody to tumor necrosis factor (TNF) (infliximab). 33 children aged 6 to 18 years with various forms of Crohn’s disease were enrolled in the study. Therapy duration ranged from 3 months to 1 year or more. After the induction course of therapy efficacy was 94%, clinical remission was achieved in 70% of patients, after 1 year of therapy efficacy of therapy was reduced to 84%, clinical remission was observed in 70% of children. Endoscopic remission rate after induction was observed in 24% of children, and in 29% after 54 weeks of therapy. After one year of treatment in 9 out of 11 children glucocorticoid therapy was completely stopped. Adverse events after infliximab administration were observed in 9% of children. One child was withdrawn from the study due to infliximab intolerance.

Infliximab is one of the first biological agents that has proven its efficacy in Crohn’s disease treatment in various multicenter randomized studies. Anticytokine treatment with infliximab allows to reach clinical, lab and endoscopic remission and secure its maintenance. This article contains clinical examples of anticytokine therpy with infliximab (Remikeid) efficacy in children with Crohn’s disease. Key words: Crohn’s disease, children, anticytokine therapy, infliximab. ( Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (5): 74–80.)

Infliximab is one of the first biological agents that has proven its efficacy in Crohn’s disease treatment in various multicenter randomized studies. Anticytokine treatment with infliximab allows to reach clinical, lab and endoscopic remission and secure its maintenance. This article contains clinical examples of anticytokine therpy with infliximab (Remikeid) efficacy in children with Crohn’s disease. Key words: Crohn’s disease, children, anticytokine therapy, infliximab. (Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (5): 74–80.)

The article presents modern data on syndrome of acute diarrhea in children, its etiology and mechanisms of development of different types of this disease, its clinical symptoms, differential diagnosis, laboratory and instrumental methods of diagnostics. Author gives review of pathogenetic treatment and opportunities of therapy with enterosorbates, taking into account etiology of diarrhea. Another chapter of the article describes opportunities and methods of oral hydration depending of extent of exicosis. Key words: acute diarrhea, children, etiology, pathogenesis, clinical symptoms, etiotropic therapy, enterosorbates, oral hydration.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2010;9(5):111-1116)

The article describes the findings of a pilot research devoted to the estimation of the efficiency of a therapy with TNF α inhibitors for children with inflammatory bowel diseases. Methods : we carried out the retrospective analysis for a therapy with Infliximab in 15 children with a nonspecific ulcerative colitis and Сrohn's disease. Results : 66% of the children with inflammatory bowel diseases react to the first injection of Infliximab, whereas 13% of the children demonstrate a clinical remission of their diseases. After the third injection, a positive response to the used therapy is shown by 60% of the children with inflammatory bowel diseases, and 33% of the children are diagnosed with a clinical remission. Conclusion: The use of Infliximab allowed the children with a refractory course of nonspecific ulcerative colitis and Сrohn's disease to make their inflammation significantly less active and improve the quality of their life. Key words: nonspecific ulcerative colitis, Сrohn's disease, treatment, TNF α inhibitors, children

The article describes the findings of a pilot research devoted to the estimation of the efficiency of a therapy with TNF α inhibitors for children with inflammatory bowel diseases. Methods: we carried out the retrospective analysis for a therapy with Infliximab in 15 children with a nonspecific ulcerative colitis and Сrohn's disease. Results: 66% of the children with inflammatory bowel diseases react to the first injection of Infliximab, whereas 13% of the children demonstrate a clinical remission of their diseases. After the third injection, a positive response to the used therapy is shown by 60% of the children with inflammatory bowel diseases, and 33% of the children are diagnosed with a clinical remission. Conclusion: The use of Infliximab allowed the children with a refractory course of nonspecific ulcerative colitis and Сrohn's disease to make their inflammation significantly less active and improve the quality of their life.Key words: nonspecific ulcerative colitis, Сrohn's disease, treatment, TNF α inhibitors, children

The authors studied the opportunities to define the level of faecal calprotectin in diagnostics of the inflammatory enteric diseases (grohn's disease and colitis gravis) among children. It was established that children, suffering from the inflammatory enteric diseases, the concentration of faecal calprotectin increases, thus, correlating with the clinical and endoscopic activity of the disease, as well as with the spread of the intestinal impairment. Faecal calprotectin may be a reliable marker of the inflammation activity in the event of grohn's disease and colitis gravis. Key words: faecal calprotectin, inflammatory enteric diseases, colitis gravis, grohn's disease, diagnostics, children .

The authors provided modern information on the basic noninvasive methods to assess the inflammatory process in the intestine in crohn's disease and colitis gravis. The researchers thoroughly described the opportunities and limitations for the use of faecal calprotectin as a marker of the inflammatory enteric diseases. Importance of this marker for the differential diagnostics of the inflammatory and functional enteric diseases has been shown.Key words: markers of the enteric inflammation, faecal calprotectin, inflammatory bowel diseases, colitis gravis, сrohn's disease.

The authors studied the opportunities to define the level of faecal calprotectin in diagnostics of the inflammatory enteric diseases (grohn's disease and colitis gravis) among children. It was established that children, suffering from the inflammatory enteric diseases, the concentration of faecal calprotectin increases, thus, correlating with the clinical and endoscopic activity of the disease, as well as with the spread of the intestinal impairment. Faecal calprotectin may be a reliable marker of the inflammation activity in the event of grohn's disease and colitis gravis.Key words: faecal calprotectin, inflammatory enteric diseases, colitis gravis, grohn's disease, diagnostics, children.